Intravenous Olanzapine in a Critically Ill Patient: An Evolving Route of Administration

Lorenzo, Michael P; Burgess, Jeni; Darko, William

doi:10.1177/0018578718823484

Cited by 10 publications

(9 citation statements)

References 22 publications

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“…Previous data in the ICU population are limited to case reports, poster abstracts, and studies involving smaller sample sizes. [5][6][7]9 The majority of patients received multiple doses of IVP olanzapine, which has not been well established in previous studies in the ICU population. 9 The inpatient population is important to analyze because most previous studies on IVP olanzapine took place in the ED setting, where repeat dosing and extended durations of therapy are uncommon.…”

Section: Discussionmentioning

confidence: 99%

“…1 Previous studies have demonstrated the off-label usage of intravenous push (IVP) olanzapine across multiple indications. 2-11 IVP olanzapine is seen as a useful option in acute agitation because it can be given rapidly in patients with IV access. 3-9 Further rationale for the off-label usage of IVP olanzapine is the thought of a faster onset of action compared with the IM route of administration, which can take up to 45 minutes to reach peak concentrations.…”

Section: Introductionmentioning

confidence: 99%

“…2-11 IVP olanzapine is seen as a useful option in acute agitation because it can be given rapidly in patients with IV access. 3-9 Further rationale for the off-label usage of IVP olanzapine is the thought of a faster onset of action compared with the IM route of administration, which can take up to 45 minutes to reach peak concentrations. 1 In addition to acute agitation, IVP olanzapine has been used off-label for the treatment of chemotherapy-induced nausea and vomiting.…”

Section: Introductionmentioning

confidence: 99%

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Safety of Intravenous Olanzapine Administration at a Tertiary Academic Medical Center

et al. 2021

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Background Although approved by the Food and Drug Administration for intramuscular administration only, analyses have described the administration of intravenous push (IVP) olanzapine, particularly for acute agitation. The safety and efficacy of IVP olanzapine has mostly been limited to emergency department patients. Objective To evaluate the safety of IVP olanzapine administration in the inpatient setting. Methods This single-center, retrospective analysis was conducted between July 1, 2018, and December 31, 2019, at Brigham and Women’s Hospital in Boston, Massachusetts. Adult patients who received at least 1 dose of IVP olanzapine were included in the analysis. Safety endpoints analyzed included the following adverse drug events (ADEs): hypotension, bradycardia, cardiac arrhythmias, extrapyramidal adverse effects, and respiratory depressive events. Data on IV site reactions, including phlebitis and infiltration, were also collected. Results A total of 1,247 IVP administrations of olanzapine were identified across 252 patients. Two or more doses were received by 159 patients (63.1%). Most administrations (66%) took place in intensive care units, with 33% administered on general medicine wards. Overall, 104 administrations (8.3%) were associated with at least 1 ADE. Hypotension and bradycardia occurred in 62 (5.2%) and 16 (1.3%) administrations, respectively. Phlebitis occurred with 8 administrations (1.4%). All other adverse events were rare (<1%). Conclusion and Relevance Hypotension, the most commonly noted ADE, occurred more frequently than in previous studies. IVP olanzapine appears to be a safe route of administration in hospitalized patients, including those receiving multiple doses. Further studies are required to evaluate the effect of IV olanzapine on hemodynamics.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Safety of Intravenous Olanzapine Administration at a Tertiary Academic Medical Center

et al. 2021

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“…QTcB 421 and QTcF 423 ms while off galantamine increased to 503 and 477 ms, respectively, after reinitiating treatment. QTcB 443 and QTcF 452 ms after discontinuing galantamine and irbesartan Olanzapine Lorenzo et al 2020 99 70 Male Agitated delirium while hospitalized Tamsulosin, terazosin, ibuprofen QTc 447 ms on admission, increased to 485 ms during hospitalization and treatment with haloperidol, ziprasidone, lorazepam, diazepam, and/or dexmedetomidine. QTc normalized after switching to olanzapine IV 2.5–5 mg every 4 hr Jeon et al 2011 97 42 Female Psychosis Olanzapine 2.5 mg/d, warfarin 3 mg/d, diazepam 4 mg/d, valproic acid 300 mg BID, topiramate 100 mg BID QTc 591 ms on admission with dysrhythmia and intermittent TdP in a patient with a history of open-heart surgery.…”

Section: Literature Searchmentioning

confidence: 99%

QTc Interval Prolongation with Therapies Used to Treat Patients with Parkinson’s Disease Psychosis: A Narrative Review

Torres‐Yaghi

Carwin

Carolan

et al. 2021

NDT

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In addition to the classic motor symptoms of Parkinson’s disease (PD), people with PD frequently experience nonmotor symptoms that can include autonomic dysfunction and neuropsychiatric symptoms such as PD psychosis (PDP). Common patient characteristics, including older age, use of multiple medications, and arrhythmias, are associated with increased risk of corrected QT interval (QTc) prolongation, and treatments for PDP (antipsychotics, dementia medications) may further increase this risk. This review evaluates how medications used to treat PDP affect QTc interval from literature indexed in the PubMed and Embase databases. Although not indicated for the treatment of psychosis, dementia therapies such as donepezil, rivastigmine, memantine, and galantamine are often used with or without antipsychotics and have minimal effects on QTc interval. Among the antipsychotics, data suggesting clinically meaningful QTc interval prolongation are limited. However, many antipsychotics have other safety concerns. Aripiprazole, olanzapine, and risperidone negatively affect motor function and are not recommended for PDP. Quetiapine is often sedating, can exacerbate underlying neurogenic orthostatic hypotension, and may prolong the QTc interval. Pimavanserin was approved by the US Food and Drug Administration (FDA) in 2016 and remains the only FDA-approved medication available to treat hallucinations and delusions associated with PDP. However, pimavanserin can increase QTc interval by approximately 5–8 ms. The potential for QTc prolongation should be considered in patients with symptomatic cardiac arrhythmias and those receiving QT-prolonging medications. In choosing a medication to treat PDP, expected efficacy must be balanced with potential safety concerns for individual patients.

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“…2 Despite lack of FDA approval, there has been an increased exploration of IV olanzapine for the management of acute agitation. 3-8 It is suggested that olanzapine may pose a better safety profile compared to IV haloperidol, including fewer extrapyramidal side effects and a lower risk of QTc prolongation and torsades de pointes (TdP). 9 Furthermore, the use of haloperidol has been associated with an increased risk for neuroleptic malignant syndrome in human studies 10 and delayed recovery in neurologic injury in animal studies.…”

Section: Introductionmentioning

confidence: 99%

Off-Label Use of Intravenous Olanzapine for Agitation After Neurologic Injury

et al. 2020

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Background: Small studies have described the off-label use of intravenous (IV) olanzapine for the management of acute agitation. Objective: The purpose of this study was to evaluate the efficacy and safety of IV olanzapine to manage acutely agitated patients with neurological injuries. Methods: This was a retrospective analysis of IV olanzapine use in patients admitted to the neurotrauma and neurovascular intensive care units at a single academic center. The primary endpoint was the requirement of additional IV olanzapine, IV benzodiazepine, or IV haloperidol within 60 minutes from the time of first IV olanzapine dose. Secondary safety endpoints included QTc prolongation and respiratory depression. Results: Forty-six patients received IV olanzapine during the study period. One patient required an additional dose of IV olanzapine and two patients received benzodiazepine or antipsychotic agents within 60 minutes of IV olanzapine administration. One patient had a post-administration QTc level >500 ms. Two patients had an increased oxygen requirement, but none required intubation. Conclusion: IV olanzapine appears to be efficacious in reducing the need for sedatives and antipsychotics with low risk for QTc prolongation and respiratory depression in acutely agitated patients with neurological injuries.

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Intravenous Olanzapine in a Critically Ill Patient: An Evolving Route of Administration

Cited by 10 publications

References 22 publications

Safety of Intravenous Olanzapine Administration at a Tertiary Academic Medical Center

Safety of Intravenous Olanzapine Administration at a Tertiary Academic Medical Center

QTc Interval Prolongation with Therapies Used to Treat Patients with Parkinson’s Disease Psychosis: A Narrative Review

Off-Label Use of Intravenous Olanzapine for Agitation After Neurologic Injury

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